Provider Demographics
NPI:1629490016
Name:LE, MONG THAO TRISHA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:MONG THAO
Middle Name:TRISHA
Last Name:LE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7772 HIGHWAY 23
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-2060
Mailing Address - Country:US
Mailing Address - Phone:504-371-9355
Mailing Address - Fax:
Practice Address - Street 1:7772 HIGHWAY 23 STE A
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-2030
Practice Address - Country:US
Practice Address - Phone:504-371-9370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA200686363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2355767Medicaid
MS04582570Medicaid
LA2355767Medicaid